Provider First Line Business Practice Location Address:
1197 HIGHWAY KK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSAGE BEACH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65065-3344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-348-5331
Provider Business Practice Location Address Fax Number:
573-348-5232
Provider Enumeration Date:
12/21/2005